Provider Demographics
NPI:1104867167
Name:FORT HAMILTON HOSPITAL
Entity Type:Organization
Organization Name:FORT HAMILTON HOSPITAL
Other - Org Name:KETTERING HEALTH HAMILTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-395-8522
Mailing Address - Street 1:2110 LEITER RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3660
Mailing Address - Country:US
Mailing Address - Phone:937-914-7601
Mailing Address - Fax:937-522-7685
Practice Address - Street 1:630 EATON AVENUE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2767
Practice Address - Country:US
Practice Address - Phone:513-867-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1117282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01540145Medicaid
LA016142002Medicaid
IN100275840AMedicaid
AZ372243Medicaid
NJ4181204Medicaid
ME431930200Medicaid
FL9126813 00Medicaid
OH2875330Medicaid
GA000472337XMedicaid
NY01884633Medicaid
AR154913105Medicaid
NC3600132Medicaid
MO016142002Medicaid
CAXHSP32617Medicaid
MI304642370Medicaid
MI404642389Medicaid
CAXHSP42617Medicaid
KY01540145Medicaid
NJ4181204Medicaid